Insulin

Types

Type	Onset of action (h)	Peak action	Effective duration	Max duration
RAPID ACTING
Lispro (humalog)	0.25-0.5	0.5-1.25	3-4	4-6
Aspart (novolog)	0.25-0.5	0.5-1.25	3-4	4-6
Glulisine (apidra)	0.25-0.5	0.25-1.25	3-4	4-6
SHORT ACTING
Regular	0.5-1	2-3	3-6	6-8
INTERMEDIATE ACTING
NPH	2-4	6-10	10-16	14-18
LONG ACTING
glargine (Lantus)	3-4	8-16	18-20	20-24
detemir (Levemir)	3-4	6-8	14	~20

Common Anti-hyperglycemic Drugs and Pharmacology

Drug	Pharmacology
	Onset	Peak	Duration
Rapid-acting insulin Aspart (Novolog) Lispro (Humalog)	15-30min	1-2h	3-5h
Short-acting insulin Regular	30-60min	2-4h	6-10h
Intermediate-acting insulin NPH (Humulin, Novolin)	1-3h	4-12h	18-24h
Long-acting insulin Glargine (Lantus)	2-4h	None	24h
Sulfonylurea Glimepiride Glipizide (Glucotrol) Glyburide (Glycron, Micronase)	–	2-6h	12-24h

See also GLP-1 agonists

Insulin Sliding Scale

• Dosing depends on the patient's level of insulin resistance.
• The example sliding scales are for regular insulin with blood glucose (BG) measured in mg/dL

Low Dose (Renal Insufficiency)

• BG 150-199: 1 unit bolus Insulin
• BG 200-249: 2 units bolus Insulin
• BG 250-299: 3 units bolus Insulin
• BG 300-349: 4 units bolus Insulin
• BG Over 350: 5 units bolus Insulin

Medium Dose (Standard)

• BG 150-199: 1 unit bolus Insulin
• BG 200-249: 3 units bolus Insulin
• BG 250-299: 5 units bolus Insulin
• BG 300-349: 7 units bolus Insulin
• BG Over 350: 8 units bolus Insulin

High Dose (Severely Insulin Resistant)

• BG 150-199: 2 unit bolus Insulin
• BG 200-249: 4 units bolus Insulin
• BG 250-299: 7 units bolus Insulin
• BG 300-349: 10 units bolus Insulin
• BG Over 350: 12 units bolus Insulin

Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

Indication	Dose	Context	Route	Population
Beta-blocker toxicity	1 unit/kg IV bolus with D50, then 0.5-1 unit/kg/hr drip	High-dose insulin euglycemic therapy	IV/IV drip	Adult
Calcium channel blocker toxicity	1 unit/kg IV bolus with D50, then 0.5-1 unit/kg/hr drip (max 2 units/kg/hr)	High-dose insulin euglycemic therapy (best evidence)	IV/IV drip	Adult
Diabetic ketoacidosis	0.1 units/kg/hr IV infusion (no bolus); reduce to 0.02-0.05 units/kg/hr when BG <250	IV insulin for moderate-severe DKA	IV drip	Adult
Diabetic ketoacidosis	0.3 units/kg SC initial, then 0.1-0.2 units/kg SC q1-2h	SC insulin for mild DKA only	SC	Adult
Diabetic ketoacidosis (peds)	0.1 units/kg/hr IV drip	DKA management	IV drip	Pediatric

See Also

• Diabetes (Main)